Abstract

The developmental origins hypothesis proposes that undernutrition during early development is associated with an increased
type 2 diabetes risk in adulthood. We investigated the association between undernutrition during childhood and young adulthood
and type 2 diabetes in adulthood. We studied 7,837 women from Prospect-EPIC (European Prospective Investigation Into Cancer
and Nutrition) who were exposed to the 1944–1945 Dutch famine when they were between age 0 and 21 years. We used Cox proportional
hazards regression models to explore the effect of famine on the risk of subsequent type 2 diabetes in adulthood. We adjusted
for potential confounders, including age at famine exposure, smoking, and level of education. Self-reported famine exposure
during childhood and young adulthood was associated with an increased type 2 diabetes risk in a dose-dependent manner. In
those who reported moderate famine exposure, the age-adjusted type 2 diabetes hazard ratio (HR) was 1.36 (95% CI [1.09–1.70]);
in those who reported severe famine exposure, the age-adjusted HR was 1.64 (1.26–2.14) relative to unexposed women. These
effects did not change after adjustment for confounders. This study provides the first direct evidence, using individual famine
exposure data, that a short period of moderate or severe undernutrition during postnatal development increases type 2 diabetes
risk in adulthood.